DHA 733 Week 6 Leading Organizational Change Example

Four Hospitals, One Nursing Workforce: Leading the Change to a Regional Staffing Model Without Losing the Staff It Was Meant to Keep

[Student Name]

University of Phoenix

DHA/733: Contemporary Leadership Issues

Week 6 Assignment

[Instructor Name]

[Date]

The health network, the staffing model, staff reactions, survey results and timeline are composites written for a model paper; research findings come from the sources cited.

At a town hall in the largest rural hospital, the chief nursing officer announced that the four hospitals would move to a regional staffing model: a shared float pool, one scheduling system and a single residency program for new graduates. The goal was to end mandatory overtime and stop floating new nurses. The room erupted. Nurses feared being sent to hospitals an hour away, losing their unit identities and having schedules set by someone who did not know them. Two experienced nurses resigned that week, citing the announcement. The regional vice president realized the change had been announced before it had been led. This paper plans how to lead it.

The Change and Its Rationale

Each rural hospital had managed its own staffing. Small hospitals could not absorb vacancies or sick calls, so they relied on mandatory overtime, floating and agency nurses. A regional model would pool experienced float nurses who choose to travel, paid a premium, and standardize scheduling and new graduate training. The rationale was sound. The process was not. The plan had been designed by executives and a consultant over three months, with no staff nurses involved, and the town hall was the first most nurses heard of it. Managers had been told a week earlier and asked to keep it confidential, so they could not answer their staff's questions.

Kotter's Eight Stages

Kotter's model breaks major change into eight stages. Leaders first make people feel why change cannot wait, then assemble a team with enough credibility to lead it, then set out where the organization is headed and how, and keep repeating that message. Next they clear away obstacles so others can act, show early visible gains, build on those gains and finally weave the new way of working into the culture (Kotter, 2012). The town hall skipped the first four stages and tried to begin at implementation.

Organizational Readiness

Weiner treats readiness as something a group holds in common: members want to make the change happen, which he calls commitment, and believe that together they can, which he calls efficacy. Both rise or fall with how much people care about the change and with their reading of its workload, the resources on hand and the surrounding conditions. Groups high on both start sooner, try harder, keep going longer and work together better (Weiner, 2009).

Assessing Readiness

A short survey after the town hall asked nurses whether they valued the goals and believed the region could carry them out. Most valued ending mandatory overtime. Few believed a regional float pool would work or that their concerns would be heard. Commitment to the goals was moderate; confidence in the plan was low. Nurses wanted the problem solved but did not trust this solution or the people proposing it.

Diagnosing Barriers With an Implementation Framework

Damschroder and colleagues revised a widely used implementation framework in 2022 after surveying its users. The update sorts influences on implementation into five groups: features of the change, forces beyond the organization's walls, the organization's own culture and structure, the individuals affected and the way the rollout is managed, and it gives new weight to the people receiving the change and to equity (Damschroder et al., 2022). The framework helped the team locate barriers systematically.

Barriers by Domain

Innovation: the float pool design did not address travel time or pay for driving between hospitals. Outer setting: travel agencies offered higher pay and flexible contracts that the region could not match. Inner setting: each hospital had its own culture and managers who feared losing control. Individuals: nurses valued unit identity, familiar colleagues and predictable schedules. Process: nurses had not been involved in design, and communication came as an announcement.

Listening to Resistance

Resistance carried useful information. Nurses' objections identified real design flaws: unpaid travel time, schedules set without local knowledge and the risk that float nurses would be sent to unfamiliar units without orientation. Treating these objections as obstruction would have lost both the nurses and the insights. The vice president met with small groups of nurses at each hospital, including night shift, and asked them to list what would have to be true for the model to work. Their lists became the design requirements for the second version.

Stage One and Two: Urgency and Coalition

The vice president restarted the process. She shared data showing agency spending, overtime hours and the loss of new graduates, and invited nurses to describe the costs of the current system. A guiding coalition was formed with staff nurses from each hospital, two managers, the chair of the nurse practice council, human resources and finance.

Stages Three and Four: Vision and Communication

The coalition wrote a vision in nurses' words: no mandatory overtime, no floating of new graduates and schedules posted six weeks ahead. Leaders communicated it through unit huddles, small group meetings and a question-and-answer page updated weekly.

Stage Five: Co-Design and Empowerment

Nurses redesigned the float pool: participation would be voluntary, travel time paid, float nurses oriented to every unit they might serve and each hospital's core staff protected from involuntary floating. Scheduling would remain with each unit, with the regional system only filling gaps, which preserved the local knowledge nurses valued.

Stage Six: Pilots and Short-Term Wins

The model was piloted between two hospitals for four months. Within the pilot, mandatory overtime fell to near zero and no new graduate was floated. Leaders publicized these wins with nurses' own accounts. A night nurse who had worked three mandatory double shifts the previous winter described her first month without one, and a new graduate described finishing orientation on her own unit. Stories from peers carried more weight than any executive memo. Problems in the pilot were shared too: the scheduling software double-booked float nurses twice, and the fix was reported openly.

Stages Seven and Eight: Scaling and Culture

After the pilot, the model expanded to all four hospitals over six months, one hospital at a time, with adjustments from pilot feedback and a nurse from the pilot units serving as a peer guide at each new site. To anchor it, float pool roles became a recognized career path, and managers' evaluations included staffing stability and staff engagement.

Measures

Implementation measures include float pool participation, schedule posting on time and orientation completion. Outcome measures include mandatory overtime hours, agency spending, first-year turnover and staff engagement. Readiness will be surveyed again at six and twelve months, and results will be shared with every unit.

Conclusion

The regional staffing model failed at first because it was announced rather than led. Kotter's stages, Weiner's readiness theory and the updated implementation framework showed what was missing and where barriers lay. By listening to resistance, co-designing with nurses and piloting, the region turned a threatened change into one that could keep the staff it was meant to keep.

References

Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17, Article 75. https://doi.org/10.1186/s13012-022-01245-0

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67